A Systems Approach To Secure Food, Good Health And A Healthy Environment

Review Article | DOI: https://doi.org/10.31579/2637-8914/001

A Systems Approach To Secure Food, Good Health And A Healthy Environment

  • Jan-Olof Drangert *

Department of Nutrition, Linkoping University, Sweden.

*Corresponding Author: Jan-Olof Drangert, Department of Nutrition, Linkoping University, Sweden.

Citation: Jan-Olof Drangert, 2018. A Systems Approach to Secure Food, Good Health and a Healthy Environment. J Nutrition and food Processing. 1(1); DOI: 10.31579/2637-8914/001

Copyright: © 2018 Jan-Olof Drangert. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: 22 December 2017 | Accepted: 06 January 2018 | Published: 05 February 2018

Keywords: pathogenic organisms; food security; environmental pollution; vulnerability; biodegradable body care products; biogas production

Abstract

Human societies have always been concerned about feeding its population. Recently, the issue has been raised whether there is enough phosphate resources to feed the growing world population (Cordell et al., 2009; Malingreu et al., 2012). The plant-nutrient phosphorus (P) has no substitute and mined P is available in only a handful of countries. Also, manufactured nitrogen (N) in fertilisers requires a large input of fossil energy i.e. natural gas. Reduced wastage of plant nutrients and recovery and recycling could substantially improve the availability of P and N.

Summary

Human societies have always been concerned about feeding its population. Recently, the issue has been raised whether there is enough phosphate resources to feed the growing world population (Cordell et al., 2009; Malingreu et al., 2012). The plant-nutrient phosphorus (P) has no substitute and mined P is available in only a handful of countries. Also, manufactured nitrogen (N) in fertilisers requires a large input of fossil energy i.e. natural gas. Reduced wastage of plant nutrients and recovery and recycling could substantially improve the availability of P and N.

Today, food security and healthy food is gaining importance to maintain public health. A gradual shift of focus is taking place: from a focus on pathogens and malnutrition to environmental pollution and improved nourishment (Lopez et al., 2006).

This article applies a systems approach to promote reduced evironmental pollution and enhanced access to plant nutrients to produce enough food. The understanding is that this will improve public health by making people less vulnerable to e.g. the effects of diarrhoeal incidences and of environmental degradation.

Two challenges for any emerging recycling society:

The global population will grow to more than 10 billion at the end of this century, of which 85% are expected to live in urban areas (OECD, 2013). Urban areas become hot spots of consumption of products and disposal of waste. This geographical concentration facilitates recovery and recycling of waste, not least the plant nutrients in waste to be used in agriculture.

Two major challenges face a recycling society: how to ascertain that urban waste is of good enough quality for use in agriculture, and that urban populations are not unduly exposed to harmful chemical substances and pathogens. In order to transform present-day chemical society to recycling society, it will be necessary to complement conventional measures to avoid pathogens with a  reduction of harmful chemical substances in order to secure public and environmental health and food security.

Pathogenic organisms (viruses, bacteria, helminths and protozoa) and chemical substances (heavy metals, persistent organic compounds, nutrients, etc.) affect humans and the environment differently. (Figure 1) summarizes and compares the effects that pathogens and chemical substances pose to human health and the environment. It follows WHO’s risk assessment of pathogens which is based on numbers or concentration of each harmful item, exposure, dose-response, vulnerability, and barriers (WHO, 2006).

Chemical substances are present in nature, but most harmful substances that humans are exposed to are man-made. Altogether there are over 140,000 substances in our chemical society (Hahnkamper-Vandenbulcke, 2016), out of which some 30,000 are used in an ordinary household. Industries introduce hundreds of new substances in products every year. The content and potential health effects of new (and old) compounds are likely to be known by industry and protected by a patent, while the users rarely know the harmful effects (EU, 2011; ECHA, 2007).

Figure 1: Risk assessment of pathogens and chemical substances based on numbers or concentration of each harmful item, exposure, dose-response, vulnerability, and barriers.

Microorganisms are present in nature and a handful of new strains or species are detected every year. Not all pathogenic organisms can multiply, and they may be preyed on or die off. Human exposure to pathogens is mainly through ingested food and water, skin penetration (snails), bites (mosquitoes), and inhalation of aerosols (viruses). Exposure therefore varies due to living conditions. The infectious dose varies from a few Ascari eggs to millions of enteric coliform bacteria. Also, vulnerability varies greatly between individuals and the effect is often seen within a short period of time (Bartram and Cairncross, 2010).

Chemical substances are usually present in small amounts. Some are degradable while others may accumulate in the human body and eventually reach harmful concentrations. Humans are exposed to chemical substances in much the same way as pathogens.  A growing concern is about the effects of breathing particulate matter and exhaust fumes (OECD, 2012). Some heavy metals (cadmium, lead etc.), persistent organic matter such as PCBs, and pesticides affect the human body functions. Symptoms are often diffuse and difficult to diagnose since the effects are only felt after extended exposure. Therefore, knowledge about dose-response and vulnerability is less for chemical substances compared to pathogens. 

Protection against health hazards can be described as barriers. Barriers against pathogens include simple measures such as washing hands and vegetables before eating, boiling water and heating food, sleep under mosquito nets, and containing excreta. Barriers against chemical hazards include promoting toxin-free products, being restrictive with medicines, avoiding breathing polluted air, washing new clothes before wearing them, etc (EC, 2013). However, most barriers against chemicals are long-term remedies which involve protecting both humans and the environment, such as only using biodegradable body care products and detergents, collecting and destroying expired medicine and left-over hazardous chemicals, and disposing of wastewater on soil rather than in water bodies.

The barriers for pathogens are largely controlled by the individual while barriers against chemical compounds, on the other hand, require collective action such as banning certain substances and introducing safe products to protect both our health and the environment. No one is against getting rid of pathogens, while restricting chemical substances may arouse strong resistance from some stakeholders. Therefore, it may be more difficult to put up barriers for chemical substances.

Potential to recover P in urban waste flows and safely use it in food production:

All urban communities try to organise the resource flows in a way that is economical and safe. In the last decade, a rethink has emerged where the two challenges to secure safe use of urban waste in agriculture and not exposing people to harmful chemical substances and pathogens, are addressed simultanteously. The novel strategy to manage resources flows - named the solid waste hierarchy - comprises actions beginning where waste originates, rather than where it ends up. Previous main focus on “end-of-pipe” treatment is thus avoided, and initial attention goes to controlling the content of consumer products. A systems-based and life-cycle thinking approach is applied here to safely manage nutrient-rich urban waste flows.

In the following, an extended waste hierarchy is introduced and applied to the handling of both solid and liquid nutrient-rich wastes including human excreta (EC, 2012; Dragnet et al., 2018). Step 1 is crucial to safe recovery and recycling of nutrients. Perhaps the most important measures are to not mixing various flows and to treat each flow separately. This idea is akin to the present methods not mixing hospital waste with household waste, and not mixing communal sewage with industrial wastewater or runoff water.

The five steps of the “extended waste hierarchy” applies to both solid and liquid waste:

Step 1.  Reduce (a) waste generation, and (b) harmful contents in products and flows;

Step 2.  Reuse the waste more or less as it is;

Step 3.  Recycle the waste as input to new products (including biogas production);

Step 4.  Incinerate to extract the energy content in the remaining waste;

Step 5.  Safely landfill residues remaining after exhausting the previous steps.

The main sources of nutrients in urban waste are found in excreta, wastewater and solid organic waste (Johnson et al., 2012). Human excreta contains some 80 % and 60 % of the total amounts of nitrogen (N) and phosphorus (P) respectively leaving a European household (Hailstorm et al., 2007) – making excreta a critical issue item for overall urban nutrient recovery. For instance, the annual total content of N, P, and potassium (K) in all toilet water in Sweden amounts to 20, 50 and 55 % of the annually sold mineral fertiliser of N, P and K respectively in the country (Johnson et al., 2012) . Such high figures are expected, since the human body essentially uses the energy in eaten food while the nutrients are excreted (Dragert, 1998).

EU data regarding flows of P-rich wastes is steadily improving (van Dijk et al., 2016) and the end-use of mined P is changing substantially over time (Senthilkumar et al., 2012; Schmid-Neset et al., 2010). van Dijk et al. provide P flow and sink data for the EU:s 27 Member States. Their primary data from 2005 shows that mined P ends up in: fertilisers (78%), feed additives (14%), food additives (2%), and detergents (6%). Figure 2 shows the potential to save and recover P from these sources by applying Steps 1 – 3. The calculated values rely on various data, assumptions and estimates given in the following (Drangert et al., 2018).   

Step 1: Recently, the EU banned the use of P in detergents, and therefore the 6% of the mined P can be saved and left in the ground. Drangert et al. (2018) suggest that the use of food and feed additives is reduced from a combined 16% to 2%, assuming there remains a valid need for some additives (Step 1a). Hence the other 14 percent can be left in the ground. According to Gustavsson et al. (2011) one-third of food is not eaten, and the assumption here is that it is possible to reduce food waste in the EU from a current 33% to 20% e.g. by buying less and eating more of the food that is bought and prepared. In this way, approximately 10 % ((0.33- 0.2) of 78%) of the initial input of mined P for making fertilisers is saved and can be left in the ground.

The lowered wastage of food, in turn, reduces the need for P in food production from 78% to 68%.In summary, the measures above could reduce mining of P by 30% (6 +14 +10), and the saved P in Step 1 can substitute 44 % (30/(78-10)) of the P needed for today’s level of eaten food (and less food waste). Alternatively, this P could be used for increased food production, or be left in the ground to extend the lifetime of phosphate mines.

In addition, a change towards more vegetarian diets could save substantial amounts of mined P, but is not proposed here because such change is deemed difficult to achieve (Foresight, 2011). However, arresting the ongoing increased consumption of meat and milk products may be within reach.

Step 2: All eaten food is subsequently excreted, and 33% of the excreted P is in the faeces and 67% in the urine (Drangert, 1998). A well-designed city infrastructure can realistically recover 90% of the P in urine for direct reuse. This recovered amount required 31% of currently mined P. In addition, the author suggests that 30% of the food waste remaining after Step 1 (required 5% of the total P) is recovered and reused directly in Step 2 e.g. as feed for animals.

Steps 3: The P in faeces or blackwater can - after treatment - be recycled in Step 3. With a well-designed infrastructure an estimated 90% of the P could be recovered. Furthermore, 70% of the food waste remaining after Step 2 could be recycled in Step 3 (required 8% of the currently mined P).

In this scenario, the same amount of food is eaten, diets remain the same, and are not affected by measures in Steps 1, 2 and 3. However, the amount of mined P that can be replaced by P recovered in Steps 2 and 3 depends on the P-efficiency or rate of losses from mine to plate. Such losses are country specific in a wide sense, and related to the kind of crop, soil, farming method, animal husbandry, transportation, storage, handling, food industry, etc. van Dijk et al. (2016) estimated that for each 1 kg of P output in food required an input of 4 - 6 kg of mined P. In other words, the P-losses from mine to plate are in the range of 75 – 85%. These differences in losses are captured in Figure 2 and in most countries the rate is likely to be in the range indicated by the dashed box.

Figure 2: Proportion of mined P for fertiliser production being replaced by P saved from reduced food waste, food/feed additives , and use of detergents (Step 1), reuse of P in urine and food waste (Step 2), and recycling of P in faeces and food waste (Step3) as a function of the percentage losses from mine to plate. The dashed box indicates the interval where most countries are likely to be. Source: Drangert et al., 2018.

The measures in Steps 1-3 have a major impact on the need to mine P irrespective of what assumptions are made about recovery rates. The smaller the losses are from mine to plate, the more can be recovered and replace mined P. Figure 2 also shows that measures in Step 1 have the greatest impact and are essentially independent of P-losses from mine to table - while providing the same amount of eaten food. Figure 2 shows that if, for example, the P-loss is 60% from mine to plate, then 68% of the currently mined P can be substituted and only 32 % is needed for the required food production. The rest of the mined P (68%) can be left in the ground for future needs. If the P-loss is 80 % instead, still only about 43 % of present-day mining is required.

This saving occurs each year. Therefore, the food production is secured since easily available P in mines will last two to three times longer and the transgression of the planetary P resource boundary is delayed by several hundreds of years. This is a major reason for the European Union to engage in recovery of nutrient resources and become a recycling society.

Incinerating all organic waste (Step 4) instead of the above measures in Steps 2 and 3 could also save mined P. Zhang et al. (2002) found that only 29 – 46 % of the total P in ashes from combustion was in plant available form. This indicates that incineration will save less P than reuse and recycling, and lead to a permanent loss of organic material together with all macronutrient other than P and K.

Flows of plant nutrients through urban areas

 A conventional urban flow of P and N is illustrated in Figure 3, where assumptions for P are similar to the ones in Figure 2. Commonly, the nutrient-rich excreta is flushed to a septic tank for partial treatment. Ideally, settled sludge is cleaned out and brought to a compost facility but, due to infrequent emptying, much of the nutrients remain in the effluent. Illegal dumping is also commonplace in developing cities. In this example, 19 % of P and 5% of N in co-composted sludge and solid organic waste can be made available for use in agriculture, while most of the N and P is lost to rivers, landfills and to the air. The urban loss rate of 81% for P does not include losses from mining and agriculture, and therefore the recovered P can only replace a small part of the total input of P in food production as indicated by van Dijk et al. (2016).

Figure 3: Illustration of present-day nutrient flows from urban households (HH).

A modified sanitation system in line with Steps 2 and 3 in the extended waste hierarchy can considerably improve the capacity to recover and recycle nutrients. Figure 4 presents a hypothetical scenario for a typical city in the developing world that has taken four measures: installed urine-diverting toilets, treatment of greywater, improved collection of biowaste, and bringing the recovered nutrients to agricultural use.

Figure 4: A scenario for nutrient flows from households (HH) in an improved sanitation system 

The separated and stored urine is a well-balanced and the least polluted fertiliser available on the market and is safely applied on agricultural soil (WHO, 2006; Jönsson et al., 2004). The nutrient loss from well-managed urine storage is small, even for nitrogen (Senecal and Vinnerås, 2017). Likewise, the composted faecal matter is likely to be of good nutrient quality and, in addition, it provides valuable organic matter to the soil. The P- and N-deficient greywater and sludge contains harmful chemical substances that may accumulate in soil (EC, 2013). Therefore, this sludge is suggested only to be applied to fertilise trees.

Residents segregate their household solid organic waste, and a solid-waste-handling company composts it, and thereby reduces previous illegal dumping. Such measures have the potential to reduce the losses of the P originating from households from 81% to 18%, while N losses are reduced from 95 % to 22 %. Half of the P and twothirds of the N disposed of by households can be gainfully returned to agricultural use. The recovered N and P can substitute mined P and manufatured N in fertilisers to an extent that is steared by the loss rate from mine to plate. As shown in Figure 2, measures in Step 1 may further reduce the need for P substantially. Accompanying the reduction in wastage of nutrients is a secured food production, enhanced sanitary conditions, and cleaner water bodies.

Conclusion

The extended waste hierarchy can guide measures to improve food production, provide almost limitless nutrients and organic soil amendments and reduce import of chemical fertilisers, reduce harmful chemical substances in the food chain, and enhance public and environmental health.

An improved food intake will make people less vulnerable to e.g. diarrhoel diseases. However, the intake of nutritious food is secured, only if the distribution is fair for all inhabitants.

References

Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.

img

Virginia E. Koenig

Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.

img

Delcio G Silva Junior

Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.

img

Ziemlé Clément Méda

Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.

img

Mina Sherif Soliman Georgy

We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.

img

Layla Shojaie

The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.

img

Sing-yung Wu

Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.

img

Orlando Villarreal

Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.

img

Katarzyna Byczkowska

Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.

img

Anthony Kodzo-Grey Venyo

Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.

img

Pedro Marques Gomes

Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.

img

Bernard Terkimbi Utoo

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

img

Prof Sherif W Mansour

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

img

Hao Jiang

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

img

Dr Shiming Tang

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

img

Raed Mualem

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

img

Andreas Filippaios

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

img

Dr Suramya Dhamija

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

img

Bruno Chauffert

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

img

Baheci Selen

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

img

Jesus Simal-Gandara

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

img

Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

img

Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

img

Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

img

Husain Taha Radhi

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

img

S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

img

Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

img

George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

img

Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

img

Khurram Arshad